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Mass diabetes screening questioned

Mass screening of high-risk patients for type 2 diabetes in general practice would have no impact on mortality rates, according to a major new GP-led study.

The findings, published in The Lancet, found that screening high-risk patients aged 40 to 69 years had no significant impact on all-cause death rates over 10 years’ follow-up.

The study comes after NICE this year recommended blood glucose checks in all high-risk patients aged 40 to 74 years, in order to identify those with diabetes or ‘pre-diabetes’.

Study leader Dr Simon Griffin, a GP in Cambridge, said the new research suggested screening alone was ‘not the answer’ to reducing the burden of diabetes.

His study – the first to evaluate the effect of type 2 diabetes screening on overall mortality – found a non-significant 2% reduction in all-cause mortality and no reduction in diabetes- or CVD-related mortality.

The controlled trial looked at 20,184 patients within the top quartile of risk for undiagnosed diabetes.

Researchers using a validated score allocated the practices to three groups: a blood glucose test followed by intensive treatment for those with diabetes; the same screening programme followed by routine diabetes care; and finally a control group where no screening took place.

Dr Griffin, assistant director of the MRC epidemiology unit at Addenbrooke’s Hospital, Cambridge, said his study supported more targeted screening: ‘It would be more efficient to assess risk in a sub-group at higher risk, identified using scores, questionnaires or simply an age threshold higher than 40 years.’

Dr Martin Hadley-Brown, chair of the Primary Care Diabetes Society and a GP in Thetford, Norfolk, said the 10-year follow-up may have been too short to detect any mortality benefit.

 

Screening evidence

  • GP-led screening of high-risk patients aged 40 to 69, followed by management of newly detected diabetes, had no impact on all-cause diabetes- or CVD-related mortality over 10 years.
  • NICE diabetes prevention guidance recommends identifying patients with ‘pre-diabetes’ followed by intensive lifestyle change of metformin.

Source: Lancet 2012, online 4 October

Readers' comments (2)

  • Vinci Ho

    It has to be targeted screening in general. However , in certain ethnic group e.g.Asians , the yield of screening could be very different . Have we got some evidences?
    This is by all means a big enough controlled trial though time of follow up can be longer.
    I still think we need better guidance to deal with all these IGT and IFG (pre diabetes if you like) picked up anyway.

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  • Im beginning to feel like a Numberologist. My job increasingly seems to be about finding people with a high/low/large/small something then spending several consultations making the number different as cheaply as possible without causing iatrogenic illness and where the absolute and relative risk benefits are dubious.

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